Painless back and muscle injections

Friday, December 10th, 2010 at 6:53 PM  

Pain is a deterrent to many patients when offered a therapeutic injection. There is some encouraging news on ways to make injections more comfortable.

A Cochrane review found that adjusting the pH, with bicarbonate, of a lidocaine injectate for local anesthesia, reduced the discomfort for patients without reducing analgesic effectiveness. The burning sensation produced by the acidic pH of lidocaine injectable is diminished by adjusting the pH upwards from the 3.5 -7.0 usually found in commercial preparations, to approximately 7.4.
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Misinformed medical advice may be harmful

Thursday, December 9th, 2010 at 7:05 PM  

A word in the mouth of a physician is as dangerous as a scalpel in the hand of the surgeon, Eugene Bauer, M.D. 1931

Women who have had breast surgery for cancer do not have more lymphedema with exercise according to a new study published in JAMA. This is an important finding because the myth has been that exercise could cause edema in women who had lymph node excision during surgery. The study showed that not only were the women who exercised stronger, but that they had a lower incidence of edema.
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Spinal Cord Stimulators- How well do they work?

Monday, December 6th, 2010 at 7:06 PM  

Results of a 2 year study on Spinal Cord Stimulation (SCS), sponsored by St Jude’s Medical, Inc., found that 70 % of patients reported 50% or better at their final two-year visit. In addition 88% of these patients reported that their quality of life was improved or greatly improved. No specifics were reported concerning measures of success aside from reduction of back pain.

These results are much better than the previously reported SCS studies, A systematic review of SCS for failed back surgery syndrome and complex regional pain syndrome showed ~ 50% of patients achieved ~50% pain relief. The devil is in the details and without them, which should include how many patients had to have surgical revision of the SCS because of complications, the number of patients able to return to work, and the reduction in use of pain medications, it is difficult to come to any conclusions about the claims of extraordinary success.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
 
“Your New York City Pain Relief Doctor”
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Darvon banned by FDA- Methadone spared

Wednesday, November 24th, 2010 at 7:08 PM  

The painkilling drug Darvon (propoxyphene) was banned this week by the
FDA because it can cause potentially fatal arrhythmias (abnormal heart
rhythms). But other pain medications, like methadone, can also cause
dangerous arrhythmias. I have been asked a few times why was Darvon
banned, but not methadone?
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Pain relief, motion, and function after rotator cuff repair may not last

Friday, October 15th, 2010 at 7:10 PM  

An important study in Clinical Orthopaedics & Related Research [468(10):2678-89], reports that over time the function of the shoulder deteriorates in a significant number of patients who underwent rotator cuff repair, despite continued in many of the same patients.
The conclusions published in the abstract are found in the next paragraph:
“The early high functional scores after primary rotator cuff repair or reconstruction of the types we performed in the 1980s did not persist. The function achieved postoperatively was lost, as ROM and strength decreased to less than preoperative values. However, alleviation of pain was long-standing in most patients. Based on our data, we should warn patients to expect less
than permanent relief with those repairs. We cannot say whether the same will apply to currently performed types of repairs.”
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Golfers with back pain

Tuesday, September 28th, 2010 at 7:11 PM  

A golfing patient I treated originally came to me with low back pain and later with and neck pain- all preventing his inner champion from blossoming. Like so many golfers he had come to accept the suffering as part of the game. He was amazed to find that he could get rid of the back pain that had plagued him for years. He wrote about it in his blog today bit.ly/9aluAt

Thank you for the mention in your blog.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
 
Your New York City Doctor”
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Source of your back, shoulder and neck pain

Thursday, August 12th, 2010 at 7:12 PM  

A 35 year old executive complained of radiating into his fingers along with difficulty using his fingers. His MRI showed bone spurs in his neck which were causing compression of the nerves going into his arm. A neurosurgeon had suggested that he have surgery to remove the spurs and to fuse the vertebra in his neck.

He was given cervical spine epidural steroids and after the 2nd injection his pain and difficulties in his hand were eliminated, but the pain in the region of his shoulder blade persisted. He felt that it was time to revisit the neurosurgeon, but I told him that pain only in the shoulder isn’t typical for a problem in the spine.
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Measuring Low Back Pain Treatment Outcomes

Thursday, June 24th, 2010 at 7:14 PM  

The article in the European Spine Journal highlights a major difficulty in assessing the effectiveness of various back pain treatments. No two studies used the same criteria to measure improvement. The lack of uniformity appears to be present in every aspect of the enigma of low back pain. Recent studies demonstrated that the tests a family physician uses to establish probability of a disc herniation may not be valid. There are inconsistent criteria for fusion vs. a simple laminectomy or foraminotomy for back pain. Injection techniques vary widely for back pain thought to be from nerve or muscle.
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Is chronic back pain adequately treated?

Tuesday, May 25th, 2010 at 7:15 PM  

I just read an article on the under treatment of chronic pain with the most common associated disease states listed as osteoarthritis, rheumatoid , fibromyalgia, and sickle–cell anemia. Since physical deconditioning is fraught with many serious negative consequences, such as obesity, high blood pressure, stroke, heart disease and diabetes in addition to be being a cause of most common pain problems, it should probably rank as a form of disease.
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Activity and quality of life

Tuesday, May 18th, 2010 at 7:18 PM  

A recent article showed that even gentle but regular physical activity in middle aged women reduced the incidence of hip fractures. Lack of exercise contributes to many of the health problems with which we are confronted- obesity, heart disease, diabetes, hypertension, dementia, , and osteoporosis. At a time when the cost of health care is so important to each of us as Americans, awareness of inexpensive interventions and self responsibility for our well being should be foremost in our minds.

Proper exercise should take into account your level of conditioning before you begin any program. Many new exercisers will strain their weak or stiff muscles causing pain and disillusionment with their new found passion and quit. Remember the most important thing about your exercise plan is that you are able to and actually return for your next scheduled session.
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